Enhancing diabetes management

Overview of Diabetes

Diabetes occurs when the body produces insufficient insulin — a hormone that keeps the blood sugar level balanced — or alternatively, does not respond properly to insulin, resulting in a high amount of sugar in the blood. Diabetes is now a disease of major concern in the Asia-Pacific and is a leading cause of death in most countries. In 2019, approximately 463 million adults (20-79 years) globally were living with diabetes; by 2045 this will rise to 700 million. In particular, the Asia-Pacific region is at the forefront of the current epidemic of diabetes – more than 60% of the people (or more than 280 million) with diabetes live in Asia, with almost one-half in China and India combined .

This is driven by rapid industrialization and urbanization, and the ensuing changes in lifestyle factors such as the rise in obesity and sedentary behaviors. Diabetes has caused a significant impact to the healthcare system and economy – to the tune of USD 760 billion dollars in health expenditure in 2019 – or 10% of total healthcare expenditures allocated to adults. Healthcare systems in the Asia-Pacific must rise to the challenge to tackle this epidemic.

Problem statements of Diabetes

Problem statement #1: Awareness, education and early intervention

With China and India being the most populous nations on the globe, it is believed that over 150 million diabetes reside in the region with more than 95% being of type 2 diabetes. As the most populous region in the world, the Asia-Pacific represents a disproportionately large share of the Diabetes burden. What’s more, 95% of cases are of the Type 2 variety (T2D). While people do usually understand that T2D is associated with excess weight and high carbohydrate diets, fewer people are aware of how to manage their diabetic situation, frequently leading to the situation becoming more severe. This not only puts a strain on the individual, but also the health system at large.

  • How can countries improve not only the awareness of TD2, but more specifically the importance of early intervention and the education around its proper maintenance, and how can such a solution work cohesively across the stakeholder groups – patients, doctors, policymakers, pharmaceutical companies?

Problem statement #2: Diagnosis

According to International Diabetes Federation, 1 in 2 people with Diabetes globally go undiagnosed. That implies that half of the Diabetes cases in the Asia-Pacific remain undiagnosed, due in large part to underserved healthcare systems and lack of rapid, cost-effective tools3. For example in India, the delivery of Diabetes screening to rural areas (which make up 70% of its population) prove to be a challenge due to distance, shortage of physicians, and limited funding.

  • What are novel ideas to improve screening for Diabetes in Asia-Pacific communities and ensure capacity for early intervention to prevent further progression of Diabetes, especially those in rural regions?
  • How will such initiatives be funded, and what are the expected benefits delivered?

Problem statement #3: Delivery of treatment

Patients with T2D, representing greater than 90% of cases, and their physicians are often reluctant to begin insulin therapy—despite evidence of its efficacy. Insulin therapy is still seen as the last resort of treatments due to the desire to avoid repeated injections as well as the perceived risks of hypoglycemia and weight gain. Insulin hesitancy among healthcare practitioners and patients, therefore, contributes to a delay in insulin therapy initiation, resulting in the onset of further complications.

  • How can we improve adoption rates of insulin therapy, by patients but also the broader healthcare system?
  • What technical or non-technical pieces are missing today that will unlock proper self-maintenance of T2D for people in the Asia-Pacific?

The prevalence of Diabetes in Asia Pacific has been growing drastically. In particular, the Western Pacific, the world’s most populous region, has more than 138.2 million people living with Diabetes, and the number may rise to 201.8 million by 2035. Such a dynamic challenges physicians’capacity to attend to growing number of people who seek help with proper care and maintenance of their Diabetes. In addition, studies showed that Diabetes is associated with substantially increased risk of comorbidity from several diseases, particularly renal disease, coronary heart disease, and ischemic stroke.

  • How should healthcare provision evolve in order to create capacity for the growing Diabetes population as well as co-morbid Diabetes community?
  • How would such a next-gen care delivery model look in terms of primary, specialty, or other place-based settings?

Problem statement #4: Financing of treatment

The total annual costs (direct medical,non-medical, and indirect) for Diabetes care in South Asia, for example, range from $483-$2,637 per patient, and on an average nearly 6% of patients with Diabetes suffer catastrophic spending, i.e. when households reduce basic income by 40% in order to cope with healthcare costs. Sufficient funding or medical insurance coverage is a key pillar to enable access of affordable treatment among Diabetic patients.

  • What could be the creative and sustainable funding schemes that the healthcare ecosystem stakeholders can leverage so as to properly manage Diabetes care in a holistic manner?
    E.g. ensuring the reimbursement/funding mechanisms are set up to consider the value of early intervention and individualised care.
  • How will the investment, impact, and ROI be measured?

Problem statement #5: Self management

Managing Diabetes is a day-to-day endeavour, from keeping blood sugars in range, to ensuring wearable and injection devices are working properly, to anticipating the impact of illness, exercise, and stress on glycaemic control. Diabetic patients already have an array of tools, guidance, and data to manage their condition such as monitoring device, apps for calculating carbs, pen needles, among others.

  • How can we “reimagine” a Diabetic patient’s experience such that self management is easier, and therefore outcomes are better achieved?
    E.g. how can we increase the awareness of proper self management techniques and integrate multiple tools available in the market to make self management more convenient?

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Thematic areas

Increasing life course immunisation

Enhancing diabetes management

Preventing Respiratory Syncytial Virus

Prioritising rare disease